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Titel: Intravitreal injection with anti-vascular endothelial growth factor (anti-VEGF) in diabetic macular edema (DME) versus vitrectomy with internal limiting membrane (ILM) peeling with anti-VEGF as an adjuvant
VerfasserIn: Abdelazim, Mohamed Gaber Okasha
Sprache: Englisch
Erscheinungsjahr: 2018
Erscheinungsort: Homburg/Saar
DDC-Sachgruppe: 610 Medizin, Gesundheit
Dokumenttyp: Dissertation
Abstract: Summary Background: Diabetic macular edema (DME) is a globally growing health problem and considered the most common form of sight-threatening retinopathy in diabetic patients. Although focal or grid laser photocoagulation was the mainstay of treatment, anti-vascular endothelial growth factor (VEGF) agents are now the standard of care. However, these therapies are expensive and some patients show inadequate response. Purpose: To determine the effect of pars plana vitrectomy (PPV) for DME with preoperative intravitreal bevacizumab (IVB) compared to anti-VEGF only. Methods: This was a retrospective study between 2011 and 2016 of 260 eyes of 130 patients who had vitrectomy for DME (n=130, PPV group, single surgeon AV) and patients who had IVI of anti-VEGF only (n=130, IVI group) were followed for at least 12 month. Charts were reviewed for best corrected visual acuity (BCVA), central macular thickness (CMT) measured by optical coherence tomography (OCT). Results: The mean BCVA in LogMAR improved from 1.08 ± 0.64 at baseline to 0.71 ± 0.55 at 12-month in the PPV group (P < 0.0001) and in the IVI group, from baseline 0.49 ± 0.39 to 0.42 ± 0.36 at 12-month (P < 0.029). The mean CMT improved from 442 ± 200 μm at baseline to 348 ±149 μm at 12-month in the PPV group (P < 0.001). The mean CMT improved from 439 ± 166 μm at baseline to 368 ± 144 μm μm at 12-month in the IVI group (P < 0.001). Preoperative IVB, compared to without IVB, leads to reduction in intraoperative (6 cases vs. 10 cases) and postoperative bleeding (3 cases vs. 13 cases). Conclusion: Vitrectomy with internal limiting membrane peeling is a cost-effective procedure which consistently results in central macular thickness reduction and leads to clinically significant improvement in BCVA comparable to serial intravitreal injection of anti-VEGF. Careful patient selection and meticulous preoperative OCT assessment are critical steps in the decision-making process. Preoperative intravitreal bevacizumab was associated with reduced intraocular bleeding intra- and postoperatively. The complication rate of vitrectomy is low and similar to what has been reported for this procedure. A large, comparative, prospective, randomized clinical trial of these two treatments is needed to determine which therapy is more effective.
Link zu diesem Datensatz: urn:nbn:de:bsz:291--ds-357407
hdl:20.500.11880/32588
http://dx.doi.org/10.22028/D291-35740
Erstgutachter: Seitz, Berthold
Tag der mündlichen Prüfung: 16-Feb-2021
Datum des Eintrags: 14-Mär-2022
Fakultät: M - Medizinische Fakultät
Fachrichtung: M - Augenheilkunde
Professur: M - Prof. Dr. Berthold Seitz
Sammlung:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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